Remote Utilization Management Specialist I

Univera Healthcare; Buffalo (NY); Hybrid; USD 28,000 - 37,000; Full time

Job summary

Univera Healthcare in Buffalo, NY is seeking an administrative support specialist to assist Utilization Management workflows. You will handle inbound/outbound calls, create authorizations via phone and Care Advance Provider Tool and fax for inpatient, outpatient, behavioral health, and durable medical equipment.

The role requires strong communication, organization, and the ability to work with multiple departments to ensure timely, compliant authorizations and responsive member service.

Qualifications

• High School Diploma or GED required.
• Experience with Microsoft Office products.
• Call center experience preferred.
• Strong analytical and problem-solving skills.
• Strong written and verbal communication skills and ability to work within a team.
• Demonstrated organizational skills to manage multiple projects and priorities.
• Self-motivated and able to work independently within teams.

Responsibilities

• Handle inbound/outbound calls delivering customer-centered service in a call center.
• Respond to customers professionally to promote services and policies.
• Perform triage for UM Services and act as primary contact for provider authorizations.
• Notify members/providers about regulatory requirements (DOH, NCQA).
• Research inquiries and respond accurately within regulatory timeframes.
• Process fax requests and maintain member privacy per policies.
• Support project/department management and assist with training UM Reps.
• Collaborate with Claims, CS, and care management for end-to-end authorizations.

Skills

Analytical skills

Communication skills

Teamwork

Problem-solving

Organizational skills

MS Office

Call center experience

Education

High School Diploma or GED

Tools

FACETS

PEGA

Care Advance Provider Tool

Job description

Univera Healthcare in Buffalo, NY is seeking an administrative support specialist to assist Utilization Management workflows. You will handle inbound/outbound calls, create authorizations via phone and Care Advance Provider Tool and fax for inpatient, outpatient, behavioral health, and durable medical equipment.

The role requires strong communication, organization, and the ability to work with multiple departments to ensure timely, compliant authorizations and responsive member service.